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IJSM. 2015; 1(1): 33-37


LOBAR TORSION FOLLOWING LEFT UPPER LOBECTOMY WITH VATS APPROACH: A CASE REPORT

George Kesov, Deyan Yordanov, Ivan Inkov, Vasil Yordanov, Teodor Badarov, Rumen Asenov, Aleksandra Dimitrova, Nikola Kyuchukov, Yuri Stoianov.

Abstract
Torsion or twisting of the left lower lobe following left upper lobe lobectomy is a rare, but severe complication. According to the literature, the outcome of this complication is necrotic pneumonitis, most often followed by pneumonectomy. According to different authors its frequency ranges between 0,1% and 0,4% from all operated patients. We treated a patient with pulmonary torsion with a favorable outcome.
Case report: A 56 years-old patient with peripheral carcinoma of the upper left lobe of the lung underwent a typical upper left lobectomy. On the third postoperative day, there was a sudden deterioration in patientís condition, which led to the diagnosis of torsion of the lower pulmonary lobe. Using the video-thoracoscopic approach we were able to restore the proper position of the remaining lobe without any ischemic parenchymal alterations. The condition of the patient was stabilized, and she was discharged without any further complications.
Discussion: The described clinical case is significant in several aspects. Firstly the emergency invasive diagnosis is essential when similar complications are suspected and is crucial for preserving the vitality of the lung parenchyma. Secondly the minimally invasive video-thoracoscopic approach is a safer procedure and it should, therefore, precede the thoracotomy.
Conclusion: The rarity of this complication is the most likely reason for the lack of reports in the literature. In our case, we were able to avoid pneumonectomy and the patient recovered well. When there are more such cases described, then we will have a functional standard algorithm to follow.

Key words: lobar torsion, pulmonary resection, VATS



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